Apply for Assistance

By submitting this online application, you agree to the following Cooper’s Cupboard requirements:

1)Provide accurate and truthful information about yourself and all pets in the household.

2)Understand that we are solely dependent on donations and may not be able to grant every request. Two pets per household will qualify for assistance. If we have the inventory, we may be able to assist up to four pets. (If you have more than two pets, kindly add their information in the additional information section below.)

3)Must be age 18 or older. Only one applicant per household will be accepted.

4)Present a photo ID with your current address each time you pick up food at the identified location. We will not give your food to someone else. Exceptions granted at our discretion.

5)Cooper’s Cupboard reserves the right to refuse assistance to any applicant, regardless of prior approval, if we determine you have not met or no longer meet our requirements.

6)Provide proof of need (one of the following);

a.Unemployment

b.Receiving disaster assistance

c.Permanent disability

d.Social Security as sole source of income

e.Housing assistance

f.No residence (residing at a shelter)

g.Minimum Wage or Less Income

7)Agree to give fresh food and water to your pets daily. Pets must not be chained outside.

8)Understand that the pet food assistance is intended to be a temporary solution and Cooper’s Cupboard should not be the only source of food for your pet(s).

9)Understand that the pet food brand you receive may not be the same brand as you currently use; therefore, your pet(s) may experience some initial stomach upset due to the change in brand. (To reduce this occurrence, mix your current brand with the donated food. You can also add a heaping tablespoon of canned pumpkin to the food.) By accepting food, all members of your household agree not to hold Cooper’s Cupboard, volunteers, and benefactors legally liable in the unfortunate event that your pet(s) become ill or the food upsets your pet(s) stomach.

10)Agree to spay/neuter your pet(s) within the first month of the start of assistance, if they are currently unaltered, and provide confirmation of up-to-date rabies vaccine and spay/neuter. We may be able to provide assistance with spay/neuter services.

11)Understand that assistance is available once per month for three months only.

12)Agree not to take in any additional animals while receiving pet food assistance from Cooper’s Cupboard.

13)Agree that no pet in your care will be used for breeding or profit.

Name *

Name

First Name

Last Name

Street Address *

City, State, Zip code *

Phone number *

Email Address *

Total number of people in home

Total number of pets in home

What has happened that you need our assistance? BE DETAILED *

How did you hear about Cooper's Cupboard ? *

Pet 1 Name, Age, and Weight *

Is pet 1 a cat or dog ? *

Pet 2 Name, Age, and Weight (limit 2) *

Is pet 2 a cat or dog ? *

Spayed/Neutered ? (Y/N) *

Vaccinations Current ? (Y/N) *

Current brand of canned food *

Current brand of dry food *

Veterinarian Name/Phone *

Message to Cooper's Cupboard/Additional information

Electronic signature. By entering your name here and clicking submit you agree to the terms listed above *